The American Medical Association recently released its report on substance use and treatment. Prescribing medication was a big topic (mentioned 71 times). But as Andrew Kessler mentioned on LinkedIn, there is not a single mention of addiction counselors, recovery support, peer recovery specialists, or—well—the word recovery at all.
This seems like a fairly big omission for the AMA. But it’s symptomatic of American addiction medicine. Only about one fifth of U.S. physicians are interested in treating patients with addiction. Countless studies report that doctors do not have the time, the institutional support, or the knowledge to treat addiction. It’s no wonder that prescribing medication and pushing the patient out the door can seem like an attractive option.
America and Europe have taken decidedly different trajectories when it comes to treating addiction. One place of divergence is social prescribing—an area where the other side of the pond is years ahead of us.
In social prescribing, a healthcare provider or other professional recommends and helps link patients to support services and activities in the community. For addiction, this might look like recommending attendance at Alcoholics Anonymous meetings. For others, it might look like a referral to a theater group for “creative therapy”. Research shows that when people are directed to recovery support like this, they’re more likely to show up than if they hadn’t.
England’s National Health Service (NHS) has embraced this effort wholeheartedly. The NHS is aiming for every person to have access to social prescribing through their GP and a network of dedicated “link workers” who help patients navigate community services. A local NHS primary care network lists Narcotics Anonymous, harm reduction services, and family support groups on their social prescribing resource list, emphasizing the goal to bring patients into the broader recovery ecosystem.
And if medication is the AMA’s best answer to treating addiction, then social prescribing would help. Twelve-step attendance is associated with greater buprenorphine retention. So is support from a peer recovery navigator and general support from one’s social network. These studies indicate that a prescription for an MOUD should be accompanied by an equally important prescription for recovery support.
Of course, social prescribing requires physicians to be knowledgeable about recovery support options, to recognize signs of addiction, and – maybe most importantly – to be feel responsible for helping patients who struggle with substance use. As overloaded as the average U.S. physician is, they do not have to do it alone. Models like the NHS’ show that there are natural roles for peer support workers to be guides for patients as they explore the many varieties of recovery support.
But it starts with the medical establishment acknowledging recovery.
Recovery Review 